Изображения страниц
PDF
EPUB
[ocr errors]

afterwards show you, are purely remittent fevers; but whether complicated with vertebral disease or not, Curved Spine is no more to be influenced by issues, setons, moxas, &c., except in so far as these horrible measures almost invariably confirm it by further deteriorating the general health of the patient.

order had been supposed to be, under all || Measles, and so forth; all of which, as I shall circumstances, an affection of the bones. Some indeed vaguely referred it to peculiarity of nervous action; while others hypothetically traced it to looseness of the ligaments. When the late Mr. Abernethy said it was owing to а rancour in the muscles," he only used an unmeaning phrase to conceal his ignorance of the entire matter; for what meaning can there in reality be in the word "rancour," when applied to a subject like this? Rancour, is an old English word for malignity or illtemper; but how can that apply to a state of perfect muscular repose,—to a palsy? Nevertheless, to Mr. Abernethy's surgical care, almost every case of spinal curvature, among the higher ranks, was at one time entrusted. What the disease really is, I shall now proceed to demonstrate.

The mast of a ship is kept erect by the stays and shrouds; if you divide or loosen these on one side, the mast falls more or less in an opposite direction. The human Spine is kept upright by a similar apparatus-the muscles. If any of these muscles from bad health become weakened or paralysed on any side, the spine, from the want of its usual supporting power, must necessarily, at that particular place, drop to the other side. But being composed of many small jointed bones-the vertebra-the Spinal column cannot, like the mast, preserve its upright form, but when unsupported, must double more or less down in the shape of a curve or obtuse angle; and the degree and situation of this curvature will depend upon the number and particular locality of the muscles so weakened or paralysed. This disease or "deformity," (for Mr. Abernethy would not allow it to be anything else,) under all its uncomplicated variations of external, internal and lateral curvature, is the result of muscular weakness or palsy; which palsy, for the most part, is a feature or termination of long remittent febrile disorder. It is often a more or less rapid developement of the usual diseases of children, Scarlet fever, Chicken-pox,

[ocr errors]

coveries denied, then pilfered! The reader will find as he proceeds that this is not the only instance of plagiarism I have to complain of.

In the commencement of most cases of this kind, the patient is taller one day than another, a proof that the curvature then very much depends upon the state of health of the hour; and never do I remember to have had such a patient who did not confess to chills and heats or vice versa. I will give you two cases in which these phenomena were observed.

Case 1.-A young lady, aged 16, had a lateral curvature of the vertebræ of the upper part of the back, (that is, a curvature to one side) causing the inferior angle of the shoulderblade to protrude. I prescribed for her calomel and quinine, in small doses, and directed her to have her spine rubbed night and morning with soap liniment. In less than a month the patient had gained three inches in height, and in two months more, she was erect.

Case 2.-A lady, 45 years of age, the mother of children, had her spine so much curved at the lower part of the loins, that, to use the phrase, her "hip grew out." This case came on suddenly. I ordered a warm plaster to be applied to the spine, and prescribed hydrocyanic acid and quinine. In three weeks she stood erect. Four years afterwards she had a return, when the same means were again successfully put in practice. These two cases, Gentlemen, were cases of simple, uncomplicated palsy of the muscles of the back. There are yet other ways in which curved spine may take place-though these still depend on a loss of Health of the general system. The mere weight of the body will in some cases produce waste, or, professionally to speak, "interstitial absorption" of particular vertebræ or of their parts. A curve of course must follow; but Curvature of the Spine is not unfrequently the effect of a consumptive disease of the substance of the vertebræ--a process by which one or more of these small bones fall into a state of ulcerative decay. Still, even in these cases

there is at the same time a greater or less loss of power in particular muscles-for the same general bad health that weakens the bones must weaken the muscles also.

I will give you two cases illustrative of this last complication.

Case 1.-Mrs. Craddock, aged 25, had, for upwards of eighteen months, great weakness in the upper third of the back, where a swelling made its appearance, gradually increasing in size. According to the statement of this woman, she had been an in-patient of the Gloucester Infirmary for seven months; during which she had been treated by issues and other local measures, but with no good effect. When I first saw her, she could not walk without assistance. Upon examination, I found a considerable ex-curvature, involving the third, fourth, and fifth vertebræ of the back, which vertebrae were also painful and enlarged, and the skin which covered them was red and shining. The patient was extremely dispirited, shed tears on the most trifling occasion, and was subject to tremblings and spasms. She was generally chilly, and suffered much from coldness of feet. She also complained of flushes. Some days she thought the "swelling" in her back was not so great as upon others; and upon these particular days, she also remarked her spirits were not so low. I directed the issues to be discontinued, and ordered a combination of hydrocyanic acid and tincture of cantharides, to be taken three times a-day. These medicines she had scarcely continued a fortnight, when the improvement in her general appearance was most decided; the protuberant part of her spine had in that period considerably diminished—her health daily became better, and in less than a month, her cure was accomplished. A permanent curve, slight when compared with her former state, still remains.

[blocks in formation]

consulted he had an issue on each side of the spine: but these, as in the former case, having been productive of no good, I ordered to be discontinued. Keeping in view the remittent and constitutional nature of the disease, I prescribed small doses of calomel and quinine. The very next day the discharge was much diminished, and a cure was obtained in about six weeks. The ulcer in that time completely healed up, but a permanent angular curve, of course, remained-trifling, however, when compared with the state in which I first found him. I might give you many other such cases, but my object is to illustrate a principle, not to confuse you with too much detail. These two cases, Gentlemen, are sufficient to show you the nature and best mode of treating, what you may call, if you please, Vertebral Consumption; though I am not so sure the schools will agree with you in the designation. The one case was in its incipient state, the other fully developed.

It occasionally happens that the matter proceeding from a diseased vertebra, instead of making its way out by the back, proceeds down in front of the loin internally, till it reaches the groin, where it forms a tumour; this tumour is called by the profession Lumbar, or Psoas, abscess. With the exception of opening the tumour to allow the collection of purulent or other matter to escape, this disease, like the cases just detailed, should be treated almost entirely by constitutional measuresby such measures as tend to the improvement of the health generally. It has been for some time the fashion to confine patients with spinal disease to a horizontal posture; and a rich harvest makers of all sorts of beds and machines have derived from the practice. In the greater number of cases this treatment is erroneous from beginning to end. Constant confinement to one posture is sufficient of itself to keep the patient nervous and ill; while his own feelings and wishes are, for the most part, the best guide as to whether he should rise, walk, sit, or lie down. In this he has no theory-the doctor too often has nothing else.

Among the numerous causes of spinal disease named in books, much stress is generally laid on the improper use of Stays, and other

D

articles of female dress. To these, however, I attribute but a very small share in the production of such disorder. You meet with every kind of spinal disease in boys,-in girls, more frequently, it is true; but this greater frequency depends upon the artificial lives. girls are compelled to lead,-their domestic occupations confining them more to the house and allowing them less freedom of general movement, and fewer opportunities of enjoying the exercises and invigorating sports of the open air.

Equally effective have I found the chronothermal principle of treatment in that particular palsy of one or more muscles of the eyeball, which gives rise to Squint, or Strasbismus, as the Faculty phrase it. Parents, who have children thus affected, will tell you that the little patients some days scarcely squint at all. You see, then, that this affection, at the commencement at least, is in most instances an intermittent disease. Can the intermission here, like that of the ague, be prolonged to an indefinite period by bark, opium, &c.? Oh, I could give you half-a-hundred instances where I have prolonged it to a cure by these remedies! In a case lately under my care, the squint came on regularly every alternate day at the same hour, and lasted an hour. The subject of it, a boy of eleven, after taking a few minute doses of quinine, never squinted more. In another case, as nearly as possible the same, I ran through almost all the chronothermal medicines ineffectually; but succeeded at last with musk. I was lately consulted in the case of a young gentleman affected with squint, who had also a tendency to curved spine. A few doses of calomel and quinine cured him of both. The subject of all these cases had corporeal chills and heats, -showing clearly that the local affections were merely developements of remittent fever. Were medical men only to attend a little more to constitutional signs, they would not, I am sure, leech, blister, and cup away at localities, as they are in general too fond of doing. If properly treated at the commencement, Squint is very generally curable by internal remedies; but when, from long neglect or ill-treatment, it has become permanent,

the position and appearance of the eye may be made all but natural by a surgical division of the opposite muscle. If the squint be partial only, a surgical operation will make the patient squint worse than ever-and even in the case of complete squint, should the paralytic muscle upon which it depends recover its power after the operation, a new squint would follow of course.

There is yet another paralytic affection of the Eye which I must explain to you. I allude to what is called Amaurosis, or Nervous Blindness. In this case, a non-medical person could not tell that the patient was blind at all, the eye being to all appearance as perfect as the healthy organ. Now, this affection, in the beginning, unless when caused by a sudden blow or shock, is almost always a remittent disease. Some patients are blind all day, and others all night only. Such cases, by the profession, are termed Hemeralopia and Nyctalopia, or day and night blindness. These, then, are examples of intermittent amaurosis ; and they have been cured and caused, like the ague, by almost every thing you can name. You will find them frequent in long voyages, -not produced in that case by exhalations from the fens or marshes, as many of the profession still believe all intermittent diseases to be,—but by depraved and defective food, with exposure to wet, cold, and hard work, perhaps, besides. In the Lancet, [8th December, 1827,] you will find the case of a girl, twelve years of age, who had intermittent blindness of both eyes, palsy of the limbs, frenzy, and epilepsy; from all of which she recovered under the use of ammoniated Copper, a chronothermal remedy. This case fully establishes the relations which these various symptoms all maintain to each other; and their remittent character, together with the mode of cure, explains the still greater affinity they bear to ague.

The remedies which I have found most efficient in permanent nervous blindness have been the chrono-thermal, or ague medicines, occasionally combined with mercury, or creosote. I will give you a case which I treated successfully by an internal remedy. Charles Emms, aged 25, stated to me that he had.

been completely blind of both eyes for upwards of nine years, four of which he passed in the Bristol Asylum, where, after having been under the care of the medical officer of that establishment, he was taught basketmaking, as the only means of earning his subsistence. He had been previously an inpatient in the Worcester Infirmary, under Mr. Pierrepoint, but left it without any benefit. Some days he perceived flashes of light, but could not even then discern the shape or shade of external objects. Before he became completely blind, he saw better and worse upon particular days. When he first consulted me, his general appearance was very unhealthy, his face pale and emaciated, his tongue clouded, appetite defective and capricious; and he described himself as being very nervous, subject to heats and chills, palpitations and tremblings, with great depression of spirits. My first prescription, quinine, disagreed; my second, silver, was equally unsuccessful; with my third, hydrocyanic acid, he gradually regained his vision-being, after an attendance of four months, sufficiently restored to be able to read large print with facility. Such has been his state for upwards of two years. I need not say his general health has materially improved his appetite, according to him, having become too good for his circumstances. In confirmation of the value of hydrocyanic acid in nervous blindness, I may mention, that Dr. Turnbull, in a recent work, has detailed some cures which he made in similar cases by applying the vapour of this acid to the Eye.

If patients, who are subject to DEAFNESS, be asked whether they hear better upon some days than others, the great majority will reply in the affirmative;-so that deafness is also for the most part a remittent disease. That it is a feature or developement of general constitutional disorder is equally certain, from the chills and heats to which the great body of patients affected with it, acknowledge they are subject. Deafness from organic change of the ear, is infinitely less frequent than that which arises from nervous or functional disorder. Hence the improvement to be obtained in the great majority of diseases of this organ,

by simply attending to the patient's general health. By keeping in view the chronothermal principle, I have been enabled to improve the hearing in hundreds of cases. One old gentleman, upwards of 70 years of age, after having been all but quite deaf for years, lately consulted me for his case; he recovered completely by a short course of hydrocyanic acid. The like good effects may also be obtained by chrono-thermal treatment in ringing of the ears, &c. Indeed, very few people get much out of health without suffering more or less from noise in the ears; sometimes so great as to cause partial deafness.

Cases of loss of the sense of Toucн, and also those of partial or general numbness, will, in the greater number of instances, be found to exhibit remissions in their course. So also will almost every instance of that exalted degree of sensibility known by the various. names of Tic douloureux, Sciatica, &c., according to the locality of the various nerves supposed to be its seat. Look at the history of these diseases. What have your surgical tricks done for their relief,—your moxas, your blisters, your division of nerves ? The only measures to which these diseases have yielded, have been the chrono-thermal remedies, bark, arsenic, iron, strychnia, prussic acid, &c., the remedies, in a word, of acknowledged efficacy in ague. I shall here present you with a case from the London Medical and Surgical Journal, illustrative of the nature of Tic when involving the nerves of the face. The pain first supervened after a fright; it returned every day at two o'clock, commencing at the origin of the suborbital nerve, extending along its course, and lasted from half an hour to an hour. Two grains of sulphate of quinine given every two hours for three days produced in so short a period a complete cure. The same prompt

and favourable effects were observed in another case of frontal tic, that appeared without any known cause. Now, this frontal tic is commonly known by the name of browague. Why then mystify us with neuropathy, neuralgia, and a host of other jaw-breaking terms, that, so far from enlightening the student upon the subject of medicine, do nothing but lead him into darkness and confusion?

All these are mere varieties of Ague; the place of pain making the only difference.

Loss of the sense of TASTE is an occasional effect of constitutional disturbance, and so is Depraved Appetite. An example of what is called Bulimia or Excessive Appetite, occurs in the lectures of Mr. Abernethy: "There was a woman in this hospital, who was eternally eating; they gave her food enough, you would have thought, to have disgusted anybody, but she crammed it all down; she never ceased but when her jaws were fatigued. She found out that when she put her feet into cold water, she ceased to be hungry." What could be this woman's inducement to put her feet in cold water in the first instance? What, but their high temperature—the Fever under which she laboured? A gentleman, who was fond of play, told me, that when he lost much money he was always sure to become ravenously hungry; but that when he won, this did not happen. The condition of his body, as well as his brain, must have been different at these different times.

To the state of corporeal temperature, we must also refer the various degrees of THIRST, from which so many invalids suffer. This, like HUNGER, when extreme, is a depraved sensation. If we have intermittent fever, so also must we have intermittent hunger and thirst among the number of morbid phenomena. Colonel Shaw, in his Personal Memoirs and Correspondence, has this remark: "I I had learned, from my walking experience, that to thirsty men, drinking water only gives a momentary relief; but if the legs be wetted, the relief, though not at first apparent, positively destroys the pain of thirst."

As yet, Gentlemen, we have confined ourselves, as much as possible, to simple or "functional" diseases,-those forms of disorder in which there does not appear any tendency to local disorganisation or decay. In our next Lecture, we shall enter into a consideration of those disorders which manifest more or less change of structure in their course. Such diseases are termed "organic," by medical writers, and to a certain extent they are more complicated than those we have

[ocr errors]

modification of treatment. In most cases of this kind, though not in all, it is my custom to prescribe one or more powers, having a general chrono-thermal influence, with one or more having a special local bearing. I have necessarily, on occasion, combined remedies which may partially decompose each other. In continuing still to do so I am justified by SUCCESSFUL RESULTS, the only test of medical truth-the ultimate end and aim of all medical treatment. A charge of unchemical knowledge has been occasionally urged against me for this, by chemists and drug compounders. But what says Mr. Locke?" Were it my business to understand physic, would not the surer way be to consult nature itself in the history of diseases and their cures, than to espouse the principles of the dogmatists, methodists, or Chemists ?" This charge, then, I am willing to share, with numerous medical men, whom the world has already recognised as eminent in their art. By such, the answer has been often given, that the human stomach is not a chemist's alembic, but a living organ, capable of modifying the action of every substance submitted to it. And here I may mention, that the late Sir Astley Cooper, when I sent him my work, "The Unity of Disease,” with that candour and gentleman-like feeling by which he was not less distinguished, than by his high eminence as a surgeon, wrote to me as follows:

"Dear Sir, I thank you most sincerely for your valuable work. I have not the least objection to being unchemical, if I can be useful; and I agree with you, that the living stomach is not a Wedgewood mortar. Yours truly,

Dr. DICKSON.

HEREDITARY

"ASTLEY COOPER."

[blocks in formation]

MORRHAGES-HEART DISEASE-PULMONARY CONSUMPTION-GLANDULAR COMPLAINTS- CONSUMP

TIVE DISEASES OF JOINTS.

GENTLEMEN,

We have hitherto derived our

just left. To a certain extent, too, they admit" illustrations of the unity and intermittent

« ПредыдущаяПродолжить »